Overview
Graves’ disease, also called toxic diffuse goiter, is an autoimmune endocrine disorder. It appears like growth in the thyroid gland and manifests the symptoms of hyperthyroidism. Therefore, Graves’ disease eventually results in hyperthyroidism (same as Hashimoto’s disease or thyroiditis).
Possible signs include muscular weakness, rapid heart rate, sleeping disorder, bulged eyes, sudden weight loss, and low tolerance to heat, among others.
The condition was named after Sir Robert J. Graves in the 1830s after he first discovered it.
Graves’ disease evolves as the outcome of the drawbacks in the immune system due to the circulating autoantibodies.
Also, Over 1.5 million cases of Graves’ disease are recorded annually in Nigeria.
Course
During its course, a flaw in the immune system sets in; thyroid-stimulating immunoglobulins bind with specific receptors (thyrotropin receptors) in the thyroid gland. This mechanism causes thyroid gland enlargement causing the follicular cells to secrete a high amount of thyroid hormones (thyroxine, T4, and triiodothyronine, T3).
In addition, this condition is linked to other autoimmune risk factors like type 1 diabetes mellitus, pernicious anemia, systemic sclerosis, myasthenia gravis, rheumatoid arthritis, celiac disease, etc. Therefore, individuals may develop Graves’ disease if they have any history of autoimmune diseases.
Key Facts
- Graves’ disease was named after the man who discovered it, Sir Joseph J. Graves, in the 19th century.
- It provokes the thyroid gland to become hyperactive, leading to hyperthyroidism.
- Its symptoms are that of hyperthyroidism.
- It initiates conditions like Graves’ dermopathy and Graves’ ophthalmopathy, which affect the skin and eyes, respectively.
- Risk factors that may lead to this condition are probably other autoimmune diseases.
- Nigeria records over 1.5 million cases of Graves’ disease annually.
- It’s more common in women.
- Onset mostly before 40 years of age.
Symptoms
Since Graves’ disease ultimately leads to hyperthyroidism, all visible signs of hyperthyroidism are symptoms of Graves’ disease. In addition, signs following other illnesses like thyroid eye disease (Graves’ ophthalmopathy) and cardiovascular crises point to Graves’ disease.
Signs of hyperthyroidism
- Aching and Wasting of muscle
- Poor sensitivity to stimulus
- Rapid heartbeat
- Drastic weight loss
- Goiter
- Poor tolerance to high temperature
- Diarrhea
Upon physical examination, the following symptoms associated with other disorders (like Graves’ ophthalmopathy, Graves’ dermopathy, and cardiac difficulties) can be observed:
- Bulge eyes (exophthalmos).
- Oligomenorrhea (disorder in the menstrual cycle)
- Conjunctivitis
- Redness of the eye (erythema)
- Lagophthalmos (inability to close eyelid completely)
- Pressure on orbit.
- Cardiac arrhythmias
- Redness and lumpiness of skin (pretibial myxedema)
- Erectile dysfunction
Invariably, a life-threatening condition called thyroid storm may become a complication of hyperthyroidism. Even upon therapy, death may occur. The disease is characterized by high fever (above 40°C), high blood pressure, fast heart rates, heart failure, and hypertension which is eventually followed by hypotension.
Other complications of Graves’ disease are miscarriages, poor fetal growth, and thyroid gland dysfunction. Osteoporosis and heart failure, among others.
Diagnosis
Diagnosing Graves’ disease is similar to diagnosing thyroiditis, hyperthyroidism, and other thyroid-related disorders. However, health professionals should be able to employ strategies that will precisely determine the existing condition. The following are examples of diagnostic tests for Graves’ disease. That is after a physical examination is carried out.
- Thyroid Function Test
This is the blood test that is done to check thyroid function. The blood test will reveal the level of thyroid hormone by observing the status of the tropic hormone (Thyroid Stimulating Hormone, TSH) secreted by the pituitary gland.
- Radioactive Iodine Uptake
The doctor may approve this measure instead. A given amount of radioactive iodine will be swallowed (meal or capsule) by the patient. The rate at which the thyroid gland absorbs the iodine will determine if there is a possible sign of Graves’ disease.
Similarly, for situations like pregnancy, a preferred test called Doppler ultrasound may be recommended by the doctor. Here, sound waves are what analyze blood flow.
- Antibody Test
For this test, the doctor will use the blood test to examine the activities of thyroid antibodies (thyroid-stimulating antibodies, TSI, and thyrotropin-binding inhibitory immunoglobulins, TBII). This will enable the doctor to prepare a better inference.
- MRI and CT scan
Clear images from MRI or CT scans may assist during diagnosis where other measures don’t give an evident result.
Causes
Medically speaking, the actual cause of Graves’ disease is not known. It’s also unclear how the autoimmune reactions that lead to it come about. However, a study has shown that several widespread factors can trigger the flaw in the immune system thus:
- Genetic Factor
As the case may be, certain unclear genetic conditions can trigger the overproduction of thyroid antibody-stimulating immunoglobulin (TSI). TSI will bind to the follicular cell receptors to produce an unregulated amount of thyroid hormone.
- Physical Factor
Conditions like post-traumatic stress disorder (PTSD) and pregnancy can trigger autoimmune reactions leading to Graves’ disease.
- Risk Factors
Risk factors like other autoimmune disorders and viral and bacterial infections can trigger the cause of Graves’ disease. These factors include:
Lupus, pernicious anemia, type 1 diabetes mellitus, autoimmune adrenal insufficiency, myasthenia gravis, Sjögren syndrome, rheumatoid arthritis, and vitiligo.
Preventions
There are no extraordinary preventive measures for Graves’ disease, as its onset is also unclear. Instead, adopting certain lifestyles matters examples:
- Avoid smoking and illegal drugs
- Eat healthily
- Regular mineral nutrition
- Cope with stress healthily.
Typical Treatment
The typical treatment or management plans for Graves’ disease can only be recommended by a healthcare professional. This condition is chronic, and therapies can only manage or temporarily treat it. These therapies aim at reducing hormonal secretion and its bodily effects.
However, conditions like pregnancy hinder specific treatments, and the doctor must choose the following positive options. Also, the side effects of some of these therapies will warrant caution and thoughtfulness. Some treatments include the following:
- Surgical Operation
The surgery, thyroidectomy (the removal of the thyroid gland), maybe the best option, especially when the condition is severe or life-threatening.
Nevertheless, any sign of hypothyroidism after the surgery will require that the patient be placed on thyroid hormone replacement therapy. The synthetic hormone levothyroxine will be given to the patient for life.
- Radioiodine intake therapy
Since the thyroid gland biochemically depends on iodine for hormone production, iodine isotope(s), radioiodine, may be taken as directed by the physician. The radioactive reaction will consequently destroy the thyroid cell, hence, leading to the cessation of thyroid hormone production.
- Medications and Beta-blockers
Drugs like methimazole may be prescribed to reduce hormonal secretion from the thyroid gland. However, as a side effect, these medications may become a potential risk factor for other infections in some individuals.
On the other hand, beta-blockers only combat the symptoms of hyperthyroidism. Beta-blockers like propranolol and atenolol will help improve heart rate and alleviate other symptoms.
Conclusion
The case of Graves’ disease is recorded in high figures across many nations of the world. This condition, however, does not have any apparent cause, nor does it have any comprehensive treatment. Hence, once symptoms are noticed, you should plan to see a doctor. The doctor will, upon diagnosis, approve suitable management plans or routines to apply.
When the condition is endured for long without treatment, it may lead to life-threatening complications which may not be treated despite therapy.
MOST COMMON
